ASSUMPTION OF RISK: My participation in the Canvas Health Stomp Out Suicide Event (the

“Event”) is voluntary. I am participating in the Event with the express understanding and

appreciation that the Event includes inherent risks and dangers that could result in property loss or

damage, personal injury, or even death. I have had the opportunity to ask questions about the risks

involved and how to avoid them. Notwithstanding, I agree that I am solely responsible for property,

my health, and my safety, and I affirm that, to the best of my knowledge, I am in good physical

health and have no medical conditions or concerns that would limit my ability to participate. By

participating in the Event, I acknowledge that my acceptance of this Waiver is a prerequisite. I

understand that my participation indicates my agreement to this legally binding document, made

freely and voluntarily.

By participating in the Event, I acknowledge that I fully understand the terms of the Waiver, that I am

of legal age and that I AM VOLUNTARILY ASSUMING FULL RESPONSIBILITY FOR ANY RISKS OF

LOSS, PROPERTY DAMAGE, OR PERSONAL INJURY, INCLUDING DEATH, that may be sustained by

me. It is my express intention that this Waiver bind me, my family, my heirs, and/or my assignees.

In consideration for participating in the Event, I hereby RELEASE, WAIVE AND DISCHARGE Canvas

Health, Inc.; HSI-Crisis Connection, LLC; or any of their owners, officers, directors, members,

agents, employees, or affiliates from any and all claims, demands, or actions for any injury,

damage, loss, cost, or expense arising from my participation in the Event, including its pre-event or

post-event activities.

PHOTOGRAPHY:

By participating in the Event, I hereby consent that Canvas Health may videotape,

interview, film, or photograph me to illustrate the activities of Canvas Health, Inc. I also grant

Canvas Health or its designee permission to use and/or publish said video, interview, film, or

photograph and further waive any right I may have to inspect and/or approve the finished product

prior to publication. Further, I agree that I shall receive no compensation of any kind for the use of

my words or likeness. I discharge Canvas Health from any and all claims which may arise from use

of any video, interview, film, and/or photographs.

I acknowledge and agree that my participation in the Event shall have the same legal force and

effect as an original signature. By participating, I accept and agree to this Waiver for all purposes.